USMLE What am I doing wrong? Need help Step 1

[peacerosetx]

I have used various commercial programs and tutoring programs and my NBMES are around 170 ( Step 1 equivalent). Been studying over a year and half 12 hours + a day on concepts UW, started Picmonic (helped NBME, but then overwhelmed by too many pictures that looked the same)

• My Uworld scores average around 50- 60% ( I read all explanations). Did UW 2X (memorized various answers)
  
• Read FA 6X
• In reviewing which NBME and UWorld questions get wrong mostly technical facts. Some are concepts that I knew, but forgot. So, used a USMLE flash card program for biochem and pharm. These scores went up last NBME.
  
• Should I use flashcards for all topics (pathology, physio etc)? I am looking for advice. Been studying over a year. Honor student in Med School. Thank you! God bless.

NB I have just started to listen to Pathoma for 2 hours a day while I make the Anki flashcards, which are pretty much from FA.

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[Kazaki]

Is English your first language?

 

[peacerosetx]

Is English your first language?

Hey Kazaki, Yes I am an American, born raised east-coast. Thank you for your reply.

 

[Kazaki]

For someone who has done the amount of prep you have done, maybe a language barrier is to blame. Pretty sure you're trolling

 

[peacerosetx]

For someone who has done the amount of prep you have done, maybe a language barrier is to blame. Pretty sure you're trolling

As an IMG this is sometimes a common issue that many of us have, even as Americans. I feel badly because I came here for help. As you can see I have been a proud member for 5+ years, yet I am called a troll. Thank you for your interest to help it is good that you are amazed as I am that nothing is helping.

I can see you have just joined our forum a few months ago, welcome. I wish you all the best with your medical studies. Please know that these forums often have people in my situation who are provided with really good guidance and help. That is why I am here, but you are correct sometimes people troll. God bless!

 

[Kazaki]

I must say I'm very surprised.
Try doing a new question bank maybe? Or just forget review material for a while and go back to reference books and study from there. That's the best I can come up with tbh. All the best!

 

[lmn]

I'm honestly not sure how you are scoring so low with that kind of prep, are you a bad test taker?

Material wise, learn Pathoma really well and I would say sketchy micro/pharm if you have the time. That along with some basic FA should really be enough to get you into at least a passing score..

 

[peacerosetx]

I'm honestly not sure how you are scoring so low with that kind of prep, are you a bad test taker?

Material wise, learn Pathoma really well and I would say sketchy micro/pharm if you have the time. That along with some basic FA should really be enough to get you into at least a passing score..

Hi Imn, Thank you for your reply. Yes, I am not such a good test taker. I did over eight sessions with MedSchool Tutors, which was very expensive, but my score did not even increase one point. They worked with me on test taking strategies. I memorized FA over a year and a half ago. I have forgotten a lot of it. So, now I am going to use Flashcards to help me re-learn the FA material. It seems a lot of the questions I am missing are simple basic memorization questions. I appreciate your advice and support. God bless!

 

[lmn]

Hi Imn, Thank you for your reply. Yes, I am not such a good test taker. I did over eight sessions with MedSchool Tutors, which was very expensive, but my score did not even increase one point. They worked with me on test taking strategies. I memorized FA over a year and a half ago. I have forgotten a lot of it. So, now I am going to use Flashcards to help me re-learn the FA material. It seems a lot of the questions I am missing are simple basic memorization questions. I appreciate your advice and support. God bless!

Ah dang, well I'm not sure if I can give better advice than 8 sessions with a professional group. Best of luck, hope pathoma and sketchy will help you get a lot of the simple fact points.

 

[peacerosetx]

Ah dang, well I'm not sure if I can give better advice than 8 sessions with a professional group. Best of luck, hope pathoma and sketchy will help you get a lot of the simple fact points.

Thank you. All the blessings with your studies as well! Sometimes it is not the most expensive things that can help, but simple things. Thank you for your insight to get back to basics that probably can help a lot

 

[Blue Flame]

Your situation most likely sounds like an understanding problem. I don't know how much time you have left to take the exam, but I would recommend going back to the very basics using Pathoma and perhaps even the Kaplan lectures. UFAP (+/- Sketchy) is the go-to strategy for most US medical students because many of us have a good foundation to begin with. This combination isn't necessarily enough for most IMGs. IMGs generally use Kaplan or even Dr. Najeeb lectures to build this foundation either because their school curriculum wasn't very aligned with USMLE material or because they're years displaced from their basic science curriculum. Whatever the reason is in your case, reading FA (which is in its core a high-yield review book) or doing UWorld (which is a learning/assessment tool designed to fine-tune and master your foundation) is not going to help much when you don't have the basics down to begin with. Good luck and hope it works out for you.

 

[peacerosetx]

Your situation most likely sounds like an understanding problem. I don't know how much time you have left to take the exam, but I would recommend going back to the very basics using Pathoma and perhaps even the Kaplan lectures. UFAP (+/- Sketchy) is the go-to strategy for most US medical students because many of us have a good foundation to begin with. This combination isn't necessarily enough for most IMGs. IMGs generally use Kaplan or even Dr. Najeeb lectures to build this foundation either because their school curriculum wasn't very aligned with USMLE material or because they're years displaced from their basic science curriculum. Whatever the reason is in your case, reading FA (which is in its core a high-yield review book) or doing UWorld (which is a learning/assessment tool designed to fine-tune and master your foundation) is not going to help much when you don't have the basics down to begin with. Good luck and hope it works out for you.

Thank you blue flame. Yes, starting this past week I listen to Pathoma he really helps get the concept down. I mean I listened to him before but it was always connected to FA. But now, I do my basic work in that topic all day. So, today I listened to acute renal failure and some other Pathoma renal videos. Then I studied the basics of these topics. And when I say basics I mean basics down to spending time to understand the electrolytes. I was surprised by how much I had forgotten; especially as the electrolytes relate to insulin, diabetes and renal failure etc. I knew the concept, but breaking it down to follow the electrolytes in their entire process helps a lot. And it is enjoyable because I feel I am finally filling in the gaps!

I mean I do not spend an inordinate of time on this, just an hour. I do not do questions, just read my notes. But it helps to connect my basic studying all day with the larger concepts.

You see a part of my issue is remembering/ memorizing things. I was starting to try flashcards

Thank you so much for figuring out why FA would not work now. Each time I have met with a tutor that is what I did, read FA + UW. ( I am not saying anything against them, they probably were not used to IMG's) No wonder my score did not go up. I needed the basics! God bless you!

 

[gobigorgohome22]

I'd highly recommend Dr. Najeeb. He's the equivalent of Dr. Sataar (Pathoma) for physiology. You have significant lack in the basic foundation and he'd be a great way to learn that. It would be time consuming to go through all his videos but well worth it in your case I believe.

Try out one or two of his videos

 

[peacerosetx]

I'd highly recommend Dr. Najeeb. He's the equivalent of Dr. Sataar (Pathoma) for physiology. You have significant lack in the basic foundation and he'd be a great way to learn that. It would be time consuming to go through all his videos but well worth it in your case I believe.

Try out one or two of his videos

Dear Gob, thank you for your input. Yes I spent time watching Dr. Najeeb. I did not complete all of his videos but many of them. And found them as you said a wonderful addition. The thing is that I learn all of this wonderful information, but I cannot remember the specifics of something in a question. So, an NBME will ask me about some concept that Dr. Najeeb clearly explained, then I get excited, and I say to myself, I know that concept in this question. Then they will continue on a windy path with the question, and I can navigate my way through where they are going, but then they end with the stem where I have to recall a specific item (rate-limiting enzyme, or genetic chromosome, or the specific name of the cell that does something, or the branching artery name that it leads to etc.) it is these specifics that I get turned around. I have watched videos like Najeeb, Kaplan (all of them), PASS, You Tube (select topics), Becker (Falcon) and all of the USMLERx Video Express.

With all that said. The bottom line is that you are correct. If my basic foundation was stronger I would not be confused about selecting between two bug choices etc since the stem would question would have enough clues to help me to distinguish among them!

Thank you so much for helping me to get back to basics. God bless you!

 

[zhopv10]

Something that helps me is being able to draw it out. Like it is one thing to watch the videos take notes and such but practice going into a room with a white board and produce the pathway and talk through the whole thing out load. Go to study groups and teach others the concepts you find hardest. I find that the action of drawing it out or explaining it to others forces you to both come to realize the holes in your own understanding and also solidify the info in your mind. Good luck!


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[gobigorgohome22]

Dear Gob, thank you for your input. Yes I spent time watching Dr. Najeeb. I did not complete all of his videos but many of them. And found them as you said a wonderful addition. The thing is that I learn all of this wonderful information, but I cannot remember the specifics of something in a question. So, an NBME will ask me about some concept that Dr. Najeeb clearly explained, then I get excited, and I say to myself, I know that concept in this question. Then they will continue on a windy path with the question, and I can navigate my way through where they are going, but then they end with the stem where I have to recall a specific item (rate-limiting enzyme, or genetic chromosome, or the specific name of the cell that does something, or the branching artery name that it leads to etc.) it is these specifics that I get turned around. I have watched videos like Najeeb, Kaplan (all of them), PASS, You Tube (select topics), Becker (Falcon) etc. Thank you so much for helping me to get back to basics. God bless you!

hummm if its trouble remembering the basics, I'd recommend something like firecracker that is flashcard based but also has a way to repeat things that you dont know more often. Not sure how familiar you are with FC but for each card you give a score of 1 (dont know at all) to 5 (know it well) and the program will repeat things with lower score more frequently compared to higher score. That way you drill down what you dont know.

Rx also has a similar program and I think it shows you the exact FA page that the card correlates to because its by the makers of FA.

 

[wjs010]

What I don't understand is A) how you memorized all of FA( that's pretty amazing) and B) why you couldn't pass with FA memorized. Sorry I don't know how to help. That's an extensive prep that should be yielding passing scores, at least


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[peacerosetx]

Dear Gob, thank you for your input. Yes I spent time watching Dr. Najeeb. I did not complete all of his videos but many of them. And found them as you said a wonderful addition. The thing is that I learn all of this wonderful information, but I cannot remember the specifics of something in a question. So, an NBME will ask me about some concept that Dr. Najeeb clearly explained, then I get excited, and I say to myself, I know that concept in this question. Then they will continue on a windy path with the question, and I can navigate my way through where they are going, but then they end with the stem where I have to recall a specific item (rate-limiting enzyme, or genetic chromosome, or the specific name of the cell that does something, or the branching artery name that it leads to etc.) it is these specifics that I get turned around. I have watched videos like Najeeb, Kaplan (all of them), PASS, You Tube (select topics), Becker (Falcon) and all of the USMLERx Video Express. Thank you so much for helping me to get back to basics. God bless you!

Something that helps me is being able to draw it out. Like it is one thing to watch the videos take notes and such but practice going into a room with a white board and produce the pathway and talk through the whole thing out load. Go to study groups and teach others the concepts you find hardest. I find that the action of drawing it out or explaining it to others forces you to both come to realize the holes in your own understanding and also solidify the info in your mind. Good luck!


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Thank you Zhopv10. That is a great idea. In fact I just bought a white board to do my biochemistry pathways for an hour three days a week. My Biochemistry bars moved on my last NBME so I am thinking that could have helped. I like the idea of talking it out thought! God bless!

 

[peacerosetx]

What I don't understand is A) how you memorized all of FA( that's pretty amazing) and B) why you couldn't pass with FA memorized. Sorry I don't know how to help. That's an extensive prep that should be yielding passing scores, at least


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Well Wsj010, that is a good point did I actually memorize FA. In fact I do not think I did. I used the 11,000 flashcards from USMLE Rx at the time and spent 7 months memorizing them. So, since they were based on FA it seemed I had memorized FA, but I have since learned that these flash-facts are not as good as studying FA striaght. Thank you for your input! God bless!

 

[Phloston]

Knowledge retention seems to be an issue here. Would recommend doing more questions and exhausting the QBanks. That would likely get the OP to above the mid-190s mark for the pass.

(And I've met lots of people who have "read FA five times." Reading like a novel isn't how you read FA. You have to sit and memorize it. No way around it.)

 

[Transposony]

Memorizing FA will get you nowhere, knowing FA inside out would !
Knowing FA means understanding the concept/mechanism behind every factoid mentioned in FA.

 

[peacerosetx]

Knowledge retention seems to be an issue here. Would recommend doing more questions and exhausting the QBanks. That would likely get the OP to above the mid-190s mark for the pass.

(And I've met lots of people who have "read FA five times." Reading like a novel isn't how you read FA. You have to sit and memorize it. No way around it.)

Pholston, you are absolutely correct that retention is the issue. I can learn a lot, but to increase what I retain is definitely a smart strategy. Thank you. God bless!

 

[peacerosetx]

Memorizing FA will get you nowhere, knowing FA inside out would !
Knowing FA means understanding the concept/mechanism behind every factoid mentioned in FA.

Yes, Transp the importance of knowing the material of FA is of importance. Actually I simply do not read it, I use it as a reference for my learning to ensure I know the topics in FA. I have tired to learn from it for years and it has not worked, but the topics are excellent. Thank you for your coax in the right direction. God bless!

 

[Shjanzey]

You are definitely doing something wrong. What has worked best for me is annotating "why" things happen instead of what happens. Knowing why you have B12 deficiency in pernicious anemia versus -- this guy presents w/pernicious anemia = B12 deficiency.

If you know that the parietal cells are destroyed, and that they produce both gastric acid and intrinsic factor, and that intrinsic factor binds to B12 so it can be absorbed -- then when NBME gives you a classic pernicious anemia question and asks you what is deficient...you get all excited because you are looking for B12, but in the answer stem there is no B12. They put HCl instead, well you can get that right too because you know why and not just a list of symptoms.

My suggestions -- make flashcards/anki that will ask a simple question. What is the pathogenesis to X-disease. If you can explain how it happens, you should be able to get the questions right. Then start making flash cards for concepts that you got confused, for example What is the difference between Churg-Strauss disease and Polyarteritis Nodosa. That should help you really differentiate disorders that share common similarities.

Then there is the hard core memorization. Pharm is my bugaboo. I have bee doing Anki + Sketchy pharm. I watch sketchy first because it gives me a framework on which I can hang extra information and helps me keep information organized into discrete boxes.

Lastly, don't memorize UWorld answers. You aren't doing yourself any favors. You need to be able to think through the answers, not just remember a similar question and take the answer that looks the closest. The explanations in UWorld are gold. You should be learning volumes from them.

Good luck

 

[peacerosetx]

You are definitely doing something wrong. What has worked best for me is annotating "why" things happen instead of what happens. Knowing why you have B12 deficiency in pernicious anemia versus -- this guy presents w/pernicious anemia = B12 deficiency.

If you know that the parietal cells are destroyed, and that they produce both gastric acid and intrinsic factor, and that intrinsic factor binds to B12 so it can be absorbed -- then when NBME gives you a classic pernicious anemia question and asks you what is deficient...you get all excited because you are looking for B12, but in the answer stem there is no B12. They put HCl instead, well you can get that right too because you know why and not just a list of symptoms.

My suggestions -- make flashcards/anki that will ask a simple question. What is the pathogenesis to X-disease. If you can explain how it happens, you should be able to get the questions right. Then start making flash cards for concepts that you got confused, for example What is the difference between Churg-Strauss disease and Polyarteritis Nodosa. That should help you really differentiate disorders that share common similarities.

Then there is the hard core memorization. Pharm is my bugaboo. I have bee doing Anki + Sketchy pharm. I watch sketchy first because it gives me a framework on which I can hang extra information and helps me keep information organized into discrete boxes.

Lastly, don't memorize UWorld answers. You aren't doing yourself any favors. You need to be able to think through the answers, not just remember a similar question and take the answer that looks the closest. The explanations in UWorld are gold. You should be learning volumes from them.

Good luck

Thank you Shj for your very thought provoking and correct information. I am very appreciative. I am going to write a more full comment later, but I just wanted to jump on while I have a short study break to say thanks. God bless you!

 

[peacerosetx]

You are definitely doing something wrong. What has worked best for me is annotating "why" things happen instead of what happens. Knowing why you have B12 deficiency in pernicious anemia versus -- this guy presents w/pernicious anemia = B12 deficiency.

If you know that the parietal cells are destroyed, and that they produce both gastric acid and intrinsic factor, and that intrinsic factor binds to B12 so it can be absorbed -- then when NBME gives you a classic pernicious anemia question and asks you what is deficient...you get all excited because you are looking for B12, but in the answer stem there is no B12. They put HCl instead, well you can get that right too because you know why and not just a list of symptoms.

My suggestions -- make flashcards/anki that will ask a simple question. What is the pathogenesis to X-disease. If you can explain how it happens, you should be able to get the questions right. Then start making flash cards for concepts that you got confused, for example What is the difference between Churg-Strauss disease and Polyarteritis Nodosa. That should help you really differentiate disorders that share common similarities.

Then there is the hard core memorization. Pharm is my bugaboo. I have bee doing Anki + Sketchy pharm. I watch sketchy first because it gives me a framework on which I can hang extra information and helps me keep information organized into discrete boxes.

Lastly, don't memorize UWorld answers. You aren't doing yourself any favors. You need to be able to think through the answers, not just remember a similar question and take the answer that looks the closest. The explanations in UWorld are gold. You should be learning volumes from them.

Good luck

Thank you Shj, you made an excellent point about the "Why." I just did UW question #463. And I got the question incorrect bc I had sleeted intimal tear--thinking aortic dissection, which was close, but it was abdominal aorta. So, the answer had to do with transmural inflammation. In short, it does help to know the why of the diseases and as it compares to the other. As of today I am going to make Anki's of the similar diseases that I get confused about. Your help has been very appreciated. The goal seems to be about clairty and your advice it a great step toward that. Thank you. God bless!

 

[Shjanzey]

Thank you Shj, you made an excellent point about the "Why." I just did UW question #463. And I got the question incorrect bc I had sleeted intimal tear--thinking aortic dissection, which was close, but it was abdominal aorta. So, the answer had to do with transmural inflammation. In short, it does help to know the why of the diseases and as it compares to the other. As of today I am going to make Anki's of the similar diseases that I get confused about. Your help has been very appreciated. The goal seems to be about clairty and your advice it a great step toward that. Thank you. God bless!

Good luck, let me know how it goes